Thursday, May 22, 2014

Cruising the Web

It's never good for the administration when even Dana Milbank is taking them to the wood shed. He's just not impressed with Obama's passive performance yesterday in which the President tried to portray the stories that have been reported all over the nation as still some sort of unproven allegations.
Obama said Wednesday that he doesn’t want the matter to become “another political football,” and that’s understandable. But his response to the scandal has created an inherent contradiction: He can’t be “madder than hell” about something if he won’t acknowledge that the thing actually occurred. This would be a good time for Obama to knock heads and to get in front of the story. But, frustratingly, he’s playing President Passive, insisting on waiting for the VA’s inspector general to complete yet another investigation, this one looking into the Phoenix deaths.
Kevin Williamson ponders Obama's tendency to act as if he hasn't been the chief executive for over five years.
As many have remarked here, Barack Obama has a strange habit of acting like somebody else has been president these past years. It’s really odd.

In his speech on the VA, the president said that he would not stand for things that he clearly and undeniably has stood for some years now, and swore that he would not tolerate that which he has been tolerating since 2009.

He’s been described as acting like a bystander to his own presidency, but it’s more like he’s a victim of it, as though the presidency were this terrible thing that just happened to him one day that he’s now courageously dealing with.

His demeanor is that of a man who has been diagnosed with cancer who puts on a brave face, gets up every morning, and reiterates his determination to “beat this thing.” (Not that I don’t think the presidency is a cancer, but that’s a point for a different post.)

It’s a remarkable talent he has. When he was getting beat up politically for his association with that goofy racist clergyman, he lectured us on the evils of racism, as though we’d been the ones sitting in on those hateful sermons. Every time he has some spectacular screw-up, which seems to be about once a quarter, he pronounces himself outraged, as though he had not failed us but had been failed himself.

So Barack Obama has sworn that he will not tolerate the incompetence of the Obama administration. I’d like to think that that means he is going to resign, but I don’t think that’s what he meant.
Byron York explains why President Obama is hesitant to fire Eric Shinseki. I'd forgotten that history. I don't think that firing Shenseki would do anything other than satisfy the country's desire for a scapegoat. The real problem is the size of the bureaucracy and the format of a single-payer medical system. The real solution would be a complete reform that gave veterans vouchers to get medical care elsewhere. But that will never happen, so political scalps are all we can hope for.

The House has voted on one proposal, the Department of Veterans Affairs Management Accountability Act of 2014 that would make it easier for career bureaucrats in the Veterans Administration to be fired for shoddy work. Wouldn't that be a wonderful thing? In the midst of the VA scandal, even 162 Democrats voted for it. We'll see what Harry Reid does with a bill that has such bipartisan support.

Kevin O'Brien, writing in the Cleveland Plain Dealer, explains why the VA medical care is a warning to the country of what would happen under a single-payer medical system.
There is no better predictor of the course of a single-payer medical system in the United States than the VA system, because it is a single-payer system.

If an enrolled patient needs something done, he or she applies to the government-run system for approval; waits until the government-run system is ready to act; accepts the government-run system's solution or, if dissatisfied, appeals to that same government-run system for relief. Because the bureaucracy pays the bill, the bureaucracy makes the decisions — when or if treatment will be given, and whether or not the patient has been well enough served.
Don't expect things to change in the wake of the publicity now shining on how bureaucrats have been gaming the system to hide their lack of attention to sick veterans.
But in the end, the bureaucracy will survive and set about restoring the illusion that it works for something other than its own preservation.

And the great triage — which is really what this is all about — will resume: A system with finite resources of money, time, talent and equipment will go back to deciding, on the basis of its own best interests, which corners to cut in which patients' care. The demand will always outstrip the bureaucracy's ability to offer treatment, so some will go without.

The VA system revelations are a scandal. But it isn't a scandal attributable to Barack Obama, nor to George W. Bush, nor to any specific administration. It is the scandal of a promise that will not be kept because it cannot be kept — the promise that a government bureaucracy will find a way to stretch limited resources far enough to meet infinite demand.

Americans who watch this story play out and fail to make the clear and obvious connection to Obamacare will be guilty of willful ignorance. The systemic flaw is identical. It's just magnified on a massive scale....

The experience of veterans who get their medical care at the sufferance of the VA should be instructive to all Americans. The VA offers precisely what Obamacare offers: not a guarantee of treatment in time of need, but a guarantee of a place in line for treatment at a time of the bureaucracy's choosing. For some, that time will never come.

Bureaucracies rightly see people as captive clients, not as customers free to take their business elsewhere. (If Obamacare is allowed to remain the law, eventually there will be no "elsewhere.") So the place in line can change — or simply disappear — to suit the needs of the bureaucracy. Unless, of course, you "know somebody."

Put government in charge of health care and medical need will be well down the list of reasons for making any decision.

When abuses come to light, everyone will be mad as hell. But after a little window dressing, the same system, based on the same false promise, with the same deficiencies and the same impossible mission, will go on and on.

Tom Blumer summarizes what we've learned about the company that was employed to process Obamacare's paper applications. It really is an amazing story of corruption and incompetence.
On July 1 of last year, the agency contracted with Serco, a company which has before and since built a history of fleecing the British and Australian governments, to process those apps. The potential price tag: $1.25 billion over five years in what the government says is “a Cost-Plus-Fixed-Fee type contract with a 12-month base period and four (4) 12-month option periods.”

If the contract’s profit is really “fixed” in the correct and not corrupt sense of the word, Serco certainly isn’t acting like it. A whistleblowing employee alleges that the company “gets paid for the number of people they employ, so they want us there even if we’re not doing anything.”

Based on the number of employees and former employees who have come forward to tell their stories to St. Louis TV station KMOV, the fact that the vast majority of the workers at the facilities Serco has established to carry out the contract are in fact doing almost nothing productive is beyond dispute.

Here is just a sample of the dozens of outrageous statements contained in the five reports (here, here, here, here, and here) KMOV had posted as of when I submitted this column:
“[W]eeks can pass without employees receiving even a single application to process.”
Employees “sit at their computers and hit the refresh button every 10 minutes … to hopefully look for an application.”
One supervisor allegedly said that “if we process one or two of these a month we have done our job.”
“Multiple employees said there were days they did not process even one application, in fact they believe they only averaged seven to nine processed applications per month since the facility opened in October, 2013.”
“1,800 people … (try) to get one of 30 applications to pop up.” (Serco originally anticipated hiring “approximately 1,500 staff.”)
“They want to hire more people even though we still don’t have work to keep the people that we have busy.”
Additionally, when supervisors knew that CMS officials were going to pay them a visit, employees were told to “dress professionally and act like we were working … (and to) pull our chairs into our cubicles and yes look at the screen as if we were reading things with fingers on the keyboard.” As PJ Media’s Glenn Reynolds has often observed: “It’s Potemkin Villages all the way down.” (All links in original)
Add in the hundreds of millions that have been spent by states to build websites that don't work to administer the program and we are reaching record levels of waste, fraud, and abuse. All presidents campaign on how they're going to cut waste, fraud, and abuse. President Obama can brag about the billions that he added to the total.

One pediatric ophthalmologist explains what it is like to have to deal with Medicaid bureaucrats who administer health insurance in a manner Franz Kafka would recognize.
The bond of trust between patient and physician has always been the essential ingredient in medicine, assuring that the patient receives individual attention and the best possible medical care. Yet often lost in the seemingly endless debate over the Affordable Care Act is how the health-care bureaucracy, with its rigid procedures and regulations, undermines trust and degrades care. In my pediatric ophthalmology practice, I have experienced firsthand how government limits a doctor's options and threatens the traditional doctor-patient bond.

I recently operated on a child with strabismus (crossed eyes). This child was covered by Medicaid. I was required to obtain surgical pre-authorization using a Current Procedural Terminology, or CPT, code for medical identification and billing purposes. The CPT code identified the particular procedure to be performed. Medicaid approved my surgical plan, and the surgery was scheduled.

During the surgery, I discovered the need to change my plan to accommodate findings resulting from a previous surgery by another physician. Armed with new information, I chose to operate on different muscles from the ones noted on the pre-approved plan. The revised surgery was successful, and the patient obtained straight eyes.

However, because I filed for payment using the different CPT code for the surgery I actually performed, Medicaid was not willing to adjust its protocol. The government denied all payment. Ironically, the code-listed payment for the procedure I ultimately performed was an amount 40% less than the amount approved for the initially authorized surgery. For over a year, I challenged Medicaid about its decision to deny payment. I wrote numerous letters and spoke to many Medicaid employees explaining the predicament. Eventually I gave up fighting what had obviously become a losing battle.

Every surgeon must have the option to modify and change a surgical plan according to actual anatomical findings that only become apparent during surgery. For example, if a general surgeon operates on a patient with a suspected acute appendicitis and finds that the patient is actually suffering from an ovarian cyst, that doctor must be free to change the plan and do what is best for the patient. The physician should not be denied payment simply because of a rigid government requirement to follow only the pre-approved plan.
Reading about the rest of this doctor's travails dealing with Medicaid helps explain why so many doctors won't take Medicaid patients. And of course, Obamacare has vastly expanded the number of people getting health care through Medicaid, sometimes in preference to the private insurance policies they previously had. And remember that the advocates of this system are the same ones who insist that government should never come between a woman and her doctor. But come between a child and her ophthalmologist - of course!

So Nancy Pelosi caved and appointed Democrats to the special committee on Benghazi. And the reason why? Hillary Clinton's supporters wanted to have some defenders on the panel.

Senator Ron Johnson rightly takes Senator Jay Rockefeller to task for saying that people who oppose Obamacare are perhaps opposing it because the President is "of the wrong color."

Daniel Henninger contemplates the West's reactions to terrorism. Too often we resort to intellectual debates and internet hand-wringing as if all that will deter those who want to kill civilians to advance their terrible agendas.
The Web is filled with exquisite pro-and-con debates about these matters, and more—NSA surveillance, CIA drones. That's great. But while we pour our energies into choreographing the dancing angels atop "our values" and what is permissible, a Boko Haram, al Qaeda or al Shabaab is fine-tuning its bombs and terror strategies. We seem self-doomed to allowing the intellectually perfect be the enemy of what's good for us. At the do-something margin, this hurts and can kill us.

Here's a save-our-girls conundrum. If you asked their parents if they would waterboard a Boko Haram captive to find where the girls are, what do you think they'd say?

Oh gosh, but we're Americans not Nigerians. Really? No, we are the world now, because from Ground Zero to Nigeria, we're all potential victims of Islamic terrorism. If waterboarding is out, then what's in? On the evidence of the Boko Haram kidnapping, whatever current U.S. policy is now on organizing and leading a global counter-offensive against terrorism, it isn't enough.

But, the Webites will reply, it's complicated, it's hard, it's expensive. All true.

Good luck, girls.
Peter Wehner describes the Obama presidency's history of "epic incompetence."
The last eight months have battered the Obama administration. From the botched rollout of the health-care website to the VA scandal, events are now cementing certain impressions about Mr. Obama. Among the most damaging is this: He is unusually, even epically, incompetent. That is not news to some of us, but it seems to be a conclusion more and more people are drawing.

The emerging narrative of Barack Obama, the one that actually comports to reality, is that he is a rare political talent but a disaster when it comes to actually governing. The list of his failures is nothing short of staggering, from shovel-ready jobs that weren’t so shovel ready to the failures of to the VA debacle. But it also includes the president’s failure to tame the debt, lower poverty, decrease income inequality, and increase job creation. He promised to close Guantanamo Bay and didn’t. His administration promised to try Khalid Sheikh Mohammed before a civilian jury in New York but they were forced to retreat because of outrage in his own party. Early on in his administration Mr. Obama put his prestige on the line to secure the Olympics for Chicago in 2016 and he failed.

Overseas the range of Obama’s failures include the Russian “reset” and Syrian “red lines” to Iran’s Green Revolution, the Egyptian overthrow of Hosni Mubarak, and Libya post-Gaddafi. The first American ambassador since the 1970s was murdered after requests for greater security for the diplomatic outpost in Benghazi were denied. (For a comprehensive overview of President Obama’s failures in the Middle East, see this outstanding essay by Abe Greenwald.) The president has strained relations with nations extending from Canada to Germany, from Israel to Afghanistan to Poland and the Czech Republic to many others. All from a man who promised to heal the planet and slow the rise of the oceans.

But that’s not all. The White House response to everything from the VA and IRS scandals to the seizure of AP phone records by the Department of Justice is that it learned about them from press reports. More and more Mr. Obama speaks as if he’s a passive actor, a bystander in his own administration, an MSNBC commentator speaking about events he has no real control over. We saw that earlier today, when the president, in trying to address the public’s growing outrage at what’s happening at the VA, insisted he “will not stand for it” and “will not tolerate” what he has stood for and tolerated for almost six years. His anger at what’s happening to our veterans seems to have coincided with the political damage it is now causing him.
Well, of course. All Obama has proven that he is good at is campaigning and basking in undeserved adulation of the naive who saw some sort of salvation in his appearance on the world stage. The Nobel Peace Prize he earned for doing nothing except giving a few speeches is emblematic of his entire presidency.